The current and future role of nurses within enhanced recovery after surgery pathways
Enhanced recovery after surgery (ERAS) pathways have been proven to expedite recovery after many procedures and reduce lengths of stay in hospital and surgical complications. However, improvements are still needed, especially in postoperative ERAS components delivered by nurses such as early mobilisation and oral feeding. This article summarises the current and possible future role of nurses within ERAS, and recommends areas for future research.
Nurses are the professionals who spend the most time with patients throughout the perioperative pathway and are known to play a vital role in delivering many components of an ERAS pathway. They frequently co-ordinate care across disciplines and ensure continuity of care. However, there is a paucity of ERAS research specific to nurses compared to other professional groups. Continual training on ERAS will be required to ensure nurses are highly educated and for the best possible ERAS implementation. In certain types of surgery, nurses may fulfil extended roles in the postoperative period, such as taking over responsibility and leadership for co-ordinating pain management, mobilisation and discharge. However, this requires a well-defined care programme, a clear definition of nursing responsibilities from surgeons, agreed discharge criteria and highly qualified nurses, along with the collection and analysis of data to test safety and efficacy.
Increasing nurse involvement in ERAS research is vital to drive improvements in care and to develop nursing roles. Nurses should have a major role in the preoperative clinic, the early postoperative phase and the follow-up post-discharge period, where the benefits of ERAS need to be further documented.
Enhanced recovery after surgery (ERAS) or fast-track pathways are well established across a wide range of surgical procedures and demonstrate consistent success in decreasing surgical stress, maintaining physiological homeostasis and expediting postoperative recovery (Ljungqvist et al, 2017)(Box 1).
Box 1.Clinical resources
The implementation of ERAS has reduced hospital lengths of stay and surgical complications, so the focus is now on accelerating post-discharge functional recovery and rehabilitation (Kehlet, 2020). Incomplete postoperative recovery, with residual cognitive impairment, sarcopenia and chronic pain for example, will limit the restoration of health and may increase the risk of long-term morbidity (Kehlet, 2020; Myles, 2020).
To help the implementation of ERAS pathways, the ERAS Society (2022) guidelines, which integrate evidence-based practices into multimodal care pathways, have been published for multiple surgical specialties, leading each profession within the surgical team, including nursing, to reconsider their roles and best practice. However, areas of postoperative recovery on the ward and post-discharge rehabilitation are still to be clearly defined in many clinical guidelines.
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